TCDSB Protocols for Concussions...Concussion PowerPoint. Parents of students who are suspected of...
Transcript of TCDSB Protocols for Concussions...Concussion PowerPoint. Parents of students who are suspected of...
Prepared by the
Physical/Health/Outdoor Education
Departments
2018-19
TCDSB
Protocols
for
Concussions
TABLE OF CONTENTS Purpose of this Document 1
Responsibilities of the Board/School/Coach/Parent/Athlete 2 - 4
Concussion Code of Conduct 5
Chart 1 – Identifying a Suspected Concussion 6
Chart 2 – Diagnosed Concussion – Steps and Responsibilities 7
Forms used to Monitor a Concussion – Summary Table 8
Incident Report 9 - 14
Concussion Diagnosed – Home Preparation for Return to School/Learn
& Return to Physical Activity
15 - 18
End of Stage 2 – Home Preparation for Return to School/Learn & Return
to Physical Activity
19
Stage 3 - Return to School/Learn & Return to Physical Activity 20 - 22
Stage 4 - Return to School/Learn & Return to Physical Activity 23 - 25
End of Stage 4 – Documentation of Medical Clearance 26 - 28
Stage 5 - Return to School/Learn & Return to Physical Activity 29
Stage 6 - Return to School/Learn & Return to Physical Activity 30
Appendices 31 - 58
Appendix 1 – TCDSB Permission Form for Athletic Activities 32 - 36
Appendix 2 – Concussion Code of Conduct Pledge 37 - 38
Appendix 3 – HEADS UP Concussion Information Sheet 39 - 41
Appendix 4 – Concussion Recognition Tool & Guidelines 42 - 55
Acknowledgements 56
Purpose of this Document
A significant number of our students are exposed to activities where there is a possibility of
sustaining a concussion. The purpose of this document is to provide an action plan for school
personnel to take the necessary actions to provide the first steps in recognizing and dealing with
a student who may have suffered a suspected concussion. This document provides the
information to school personnel so that they can develop an action plan to:
Diagnose concussions and prevent further injury
Recognize the symptoms of a concussion
Know the first steps to dealing with a possible concussion and then to feel
empowered to contact appropriate medical authorities
What is a Concussion?
A concussion is a traumatic brain injury that causes changes in how the
Brain functions, leading to signs and symptoms that can emerge immediately
or in the hours or days after the injury. It is possible for symptoms to take up
to 7 days to appear
What Causes a Concussion?
A concussion may be caused by a jarring impact to the head, face, neck or body, With an impulsive force transmitted to the head, that causes the brain to move Rapidly and hit the walls of the skull (for a visual description of how a concussion
occurs consult: https://cdn.hockeycanada.ca/hockey-canada/Hockey-
Programs/Safety/Concussion/Infographic/english.html
Signs and Symptoms of a Concussion can be Physical, Cognitive,
Emotional/Behavioral, and/or related to sleep, also
Headache;
Dizziness;
Difficulty concentrating or remembering;
Depression or irritability; and
Drowsiness or difficulty falling asleep.
Though concussions are common sport injuries, particularly among children and adolescents,
the subtle symptoms of concussions may go unnoticed.
Without identification and proper management, a concussion can result in permanent
or severe brain damage
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A Board Plan of Action for Awareness of the TCDSB
Concussion Protocol
1) The TCDSB Health and Physical Education Department will provide appropriate in-
servicing to school administrators on the implementation of the TCDSB Concussion
Protocol.
2) The TCDSB Health and Physical Education Department will distribute to all
Athletic Representatives and Department Heads of Physical Education the OPHEA
Safety Guidelines, which will alert staff to the prevention of concussions.
3) The TCDSB Health and Physical Education Department will provide coaches appropriate
orientation to the Concussion Protocol through a standing item at Athletic Representatives
Regional Meetings in September of each school year.
4) The TCDSB Health and Physical Education Department will provide parents with
Concussion Prevention Education as well as appropriate orientation to the Board’s
Concussion Protocol.
5) Each school principal will in-service school staff annually, in September, on the
Concussion Protocol.
6) The TCDSB Health and Physical Education Department will develop and implement a
Code of Conduct for student athletes and coaches.
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A School Plan of Action for Concussions
A concussion is a brain injury that changes how the brain functions leading to symptoms that
can be physical (e.g., headache, dizziness), cognitive (e.g., difficulty concentrating or
remembering), emotional/behavioral (e.g., depression, irritability) and/or related to sleep
(e.g., drowsiness, difficulty falling asleep). It cannot normally be seen on routine x-rays, CT
scans, or MRIs. You do NOT need to lose consciousness to have a concussion.
School Board Responsibilities:
As more information becomes available about the impact of blows to the head, students and
staff alike must become aware of the protocol to follow in order to respond to a student who
has sustained a possible concussion. As per School Board Responsibilities required in PPM
158.
School Responsibilities:
An effective plan of action to meet this challenge of protecting students and staff should
include the following:
Principal to review the Toronto Catholic District School Board Concussion
Protocol and Guidelines with all school staff at the very first staff meeting of the
school year. Principal is to ensure TCDSB staff use only the forms provided by TCDSB. Principal to present the Concussion Protocol and Guidelines to parents at the
first or second Catholic School Advisory Council (CSAC) meeting.
A copy of the Concussion Protocol and Guidelines is to be kept in a prominent
place in the main office where staff can easily access the forms.
Principal must advise all appropriate school personnel (e.g. specialist teachers, occasional teachers, volunteers and coaches) of relevant information pertaining to
any concussed student.
Coaches Responsibilities: Inform student athletes and their parents about the seriousness of concussions and
the signs and symptoms of concussions
Follow the Concussion Code of Conduct and also have student athletes follow the
Concussion Code of Conduct
Be aware of and follow the Concussion Protocols
TCDSB/School Responsibilities: If parents/guardians do not return
TCDSB Incident Form or return student to school against medical
advice.
There is liability to TCDSB if it is known that a doctor has advised that a child should not yet Return to School/Learn, and TCDSB permits the child to Return to School/Learn anyway.
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In such circumstances, it would be prudent for the Principal to deliver a message in writing to the parent(s)/guardian(s), that the Principal strongly
advises the parent(s)/guardians(s) that the child should not Return to
School/Learn until permitted to do so by a doctor.
As TCDSB cannot contract out of liability or negligence in such a situation and
Program Policy Memorandum (PPM) 158 authorizes schools and the board to effectively guide a student’s Return to School/Learn, the TCDSB protocol advises
that if a concussion is suspected, students will not Return to School/Learn unless medical clearance has been received.
A parent/guardian cannot insist the child Return to School/Learn. When the child does return, a safety plan would need to be developed by the principal
in conjunction with appropriate school staff to help mitigate the chance of new/re-injury.
Parent Responsibilities:
Parents/Guardians are responsible for reviewing the Heads Up Concussion
Information Sheet provided by the school and/or reviewing the Parent/Guardian Concussion Guideline PowerPoint provided on the TCDSB Board website.
Parents/Guardians must sign off on the permission form indicating they have
reviewed the Heads Up Concussion Information Sheet and/or the Parent/Guardian
Concussion PowerPoint.
Parents of students who are suspected of having a concussion must:
Complete TCDSB Documentation of Medical Examination and return to the school
principal or designate accompanied by a doctor’s note
Inform your child’s school. At that point the school’s Concussion Protocol would
come into effect. TCDSB Documentation of Medical Examination would be
completed and returned to the school accompanied by a doctor’s note.
Athlete’s Responsibilities:
Athletes are responsible for reviewing the Heads Up Concussion Education
Information Sheet and/or the TCDSB Parent/Guardian Concussion Guideline
PowerPoint provided on the TCDSB Board website.
Follow the Concussion Code of Conduct
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CONCUSSION CODE OF CONDUCT
Prior to the sport season/intramural activity beginning of the school year,
Teacher/Coach/Supervisor should inform students/athletes about:
The seriousness of concussion and the signs and symptoms of concussion.
The importance of respecting and following the rules of the game and practicing fair play.
The importance of practicing good sportsmanship, respecting their opponents and officials
at all times.
The importance of informing the teacher/coach/supervisor of any signs or symptoms of a
concussion and removing themselves from the activity.
The importance of encouraging a teammate with signs or symptoms of a concussion to
remove themselves from the activity and to inform the teacher/coach/supervisor.
The importance of informing the teacher/coach/supervisor when a
classmate/teammate/opponent has signs or symptoms of a concussion.
The importance of discouraging others from pressuring injured students/athletes to
play/participate.
During the physical activity unit/sport season/intramural activity, the Teacher/Coach/Supervisor
should:
Demonstrate safe contact skills during controlled practice sessions prior to competition.
Demonstrate respect for the mutual safety of fellow athletes (For example, no hits to the
head, follow the rules and regulations of the activity).
Report any sign or symptom of a concussion immediately to teacher/coach/supervisor from
a hit, fall or collision.
Encourage teammates/fellow students to report sign(s) or symptoms of a concussion and to
refrain from pressuring students/athletes to play.
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CHART 1: Identifying a Suspected Concussion – Steps and Responsibilities
Student: Receives a jarring impact to the head, face, neck, or elsewhere on the body that transmits
an impulsive force to the head (observed or reported), and the individual (e.g., teacher/coach/supervisor) responsible for that student suspects a concussion
Teacher/coach/supervisor: Stops student participation, initiates Emergency First Aid Response
NO YES
NO YES
Student: No concussion sign(s) and/or symptom(s)
observed or reported
Student: Concussion sign(s) and/or symptom(s) observed or
reported
Student: Returns to school, but may
not resume any physical activity for 24 hours
Student: May not resume physical activity and requires an
urgent Medical Assessment
Teacher/coach/supervisor:
Contact parent/guardian and provide information on the incident and importance of monitoring for 24 hours. Provide INCIDENT REPORT & DOCUMENTATION OF MEDICAL ASSESSMENT FORM. Inform principal of the possible concussion event
Teacher/coach/supervisor:
Contact parent/guardian and provide information on: the injury and the need to pick up student; student needs an urgent Medical Assessment. Provide DOCUMENTATION OF MEDICAL ASSESSMENT FORM Inform principal of suspected concussion
Teacher/coach/supervisor: Contact parent/guardian and provide information on the injury and name of hospital. Inform principal of suspected concussion
Parent/guardian/school: Continued monitoring for
24 hours for delayed sign(s) and/or symptom(s)
Principal/designate informs school
staff of suspected concussion
NO YES
Parent/Guardian must report
results of 24 hour monitoring. If
after 24 hours no sign(s) and/or symptom(s)
emerge student is permitted to
resume physical activity. Medical
Clearance not required
Parent/Guardian must report
results of 24 hour monitoring. If sign(s) and/or symptom(s)
emerge, student needs an urgent
Medical Assessment as
soon as possible that day
Student: CONCUSSION DIAGNOSED
© Ophea 2018
Teacher/coach/supervisor: Check for Red Flag Sign(s) and/or Symptom(s)
STEP A
Teacher/coach/esruvpsi or: Check for Other Concussion Sign(s) and
Symptoms(s) - STEP B
Teacher/coach/supervisor:
Follow Red Flag Procedure - Call 911
Parent/guardian:
Report to principal outcome of Medical Assessment
CHART 2: Diagnosed Concussion - Stages and Responsibilities
Student: CONCUSSION DIAGNOSED
Principal/designate: Informs appropriate school staff of the diagnosis, and meets with parent/guardian to provide and explain the HOME PREPARATION for RTS and RTPA PLAN
Home Preparation for Return to School/Learn (RTS) and Return to Physical Activity (RTPA) Plan – completed at home
Student returns to school to begin the School Concussion Management Plan – Return to School/Learn (RTS) and Return to Physical Activity (RTPA) Plan - completed at school
Parent/guardian:
Reports to principal/designate that student has completed:
Stage 2 RTS
Stage 2b RTPA
Principal/designate: Meets with parent/guardian to: provide and explain the purpose of RTS/RTPA PLAN, & explain sthe Collaborative Team approach and their role on the team
Student:
Returns to School Student conference to develop RTS and RTPA Plan
At the completion of each stage student progress is documented with results shared between school and home. Parent/guardian confirms completion of each stage by returning documents with a signature. At each stage student is monitored for return of symptoms, new and worsening symptoms. During RTS Stages 1- 4b and RTPA 1-4, if the student exhibits/reports return of symptoms or new symptoms student must return to the previous stage for a minimum of 24 hours. If during any Stage the student exhibits or reports worsening symptoms, student must return to medical doctor/nurse practitioner.
Return to School/Learn – Stage 3a
Student: attends school (2 hours) with adaptations of learning strategies and/or approaches
Return to School/Learn –
Stage 3b Student: attends school (half time)
with moderate workload
Return to School/Learn –
Stage 4a Student: attends full day school
with adaptations of learning strategies and/or approaches
Return to School/Learn –
Stage 4b Student: attends full day school without adaptations of learning strategies and/or approaches
RTS - Complete
Return to Physical Activity – Stage 3
Student: simple locomotor activities/sport-specific exercise
to add movement
Return to Physical Activity –
Stage 4 Student: increase physical activity, non-contact training drills to add
coordination and increase thinking
Collaborative Team Lead/Designate: Report to parent/guardian completion of Stage 4b RTS and Stage 4 RTPA and provides Documentation for Medical Clearance Form
Parent/guardian: Provides principal with signed Medical Clearance accompanied by Doctor's Note.
During RTPA Stages 5 and 6, if student exhibits a return of symptoms or new symptoms the student must obtain Medical Clearance reassessment
Return to Physical Activity – Stage 5
Student: full participation in physical activities (physical education, intramurals, non- contact interschool sports) and full contact training/practice in contact sports
© Ophea 2018
Return to Physical Activity – Stage 6
Student: unrestricted return to contact sports
RTPA - Complete
TCDSB Forms used to Monitor Concussion
Activity TCDSB Form Needed
Process Action
Suspected
Concussion
Incident Form Staff Generated Filled out by staff and copy
given to Parent
Documentation of Medical Examination
Doctor Examination Signed and returned by
Parent/Guardian
No concussion File Documentation of Medical Examination in OSR. No further action required.
Concussion
Diagnosed Follow Return to School/Learn (RTS) and Return to Physical Activity
(RTPA) Protocol as indicated below
Return to School/Learn,
Return to Physical Activity
Protocol
TCDSB Forms
Used Actions
Signed By
Home Preparation for Return
to School/Learn/Return to
Physical Activity
Step 1
Stage 1
Stage 2
-Package given by school to parent.
-Parent monitors student and checks off
stages.
-Parent returns signed package and
meets with Principal once stage 2 is
completed
Parents/ Guardians
RTS / RTPA 3 Stage 3
- RTS 3
- RTPA 3a
-Develop an individualized plan
collaboratively between child, parent,
principal, and teacher.
-Hand out stage 3 package.
-Parent and school complete RTS 3 & RTPA
3a -Parent returns signed package
Parents/ Guardians &
School Designate
Stage 3
- RTS 3b
-School follows RTS 3b guidelines and child
continues with RTPA 3
-Parent monitors child at home -Both school and parent complete 3b
Parents/ Guardians &
School Designate
RTS / RTPA 4 Stage 4
- RTS 4a
- RTPA 4
-Hand out stage 4 package.
-Parent and school complete RTS 4a &
RTPA 4 -Parent returns signed package
Parents/ Guardians &
School Designate
Stage 4
- RTS 4b
-School follows RTS 4b guidelines and child
continues with RTPA 4
-Parent monitors child at home -Both school and parent complete 4b
Parents/ Guardians &
School Designate
Complete Documentation for Medical Clearance Form (End of Stage 4) - required before moving on to RTPA
Stages 5 & 6
RTPA 5 Stage 5 -Hand out stage 5 sheet.
-Parent and school complete RTPA 5
-Parent returns signed sheet
Parents/ Guardians &
School Designate
RTPA 6 Stage 6 -Hand out stage 6 sheet.
-Parent and school complete RTPA 6 -Parent returns signed sheet
Parents/ Guardians & School Designate
If symptoms return student returns to previous step and process is repeated.
Stages are not days – each stage must take a minimum of 24 hours. The length of time needed to complete
each step will vary based on the severity of the concussion and the student.
ONLY FORMS PROVIDED BY TCDSB ARE TO BE USED 8
TCDSB Incident Report – Tool to Identify a Suspected Concussion
This checklist tool, completed by school staff (for example, teachers/coaches/intramural supervisors),
is used to identify the sign(s) and/or symptom(s) of a suspected concussion, to respond appropriately
and to communicate this information and follow-up requirements to parent/guardian. This tool may
also be used for continued monitoring of the student.
Complete appropriate steps below.
Student name: Time of Incident: A.M. P.M. Date:
Identif ication of Suspected Concussion: If after a jarr ing impact to the head, face or neck
or elsewhere on the body, an impulsive force is transmitted to the head (observed or
reported), and the individual (for example, teacher/coach) responsible for that student
suspects a concussion, the following actions must be taken immediately:
STEP A
RED FLAGS:
Check ( ) for Red Flag sign(s) and or symptom(s).
If any one or more red flag sign(s) or symptom(s) are present, CALL 911 , followed by a call to
parents/guardians/emergency contact .
Neck pain or tenderness
Severe or increasing headache
Deteriorating conscious state
Double vision
Seizure or convulsion
Vomiting
Weakness or tingling/burning in arms or legs
Loss of consciousness
Increasingly restless, agitated or combative
If Red Flag(s) identified, complete only Step E – Communication to Parent/Guardian
STEP B
Other Sign(s) and Symptoms(s)
If red f lag(s) not identif ied continue and complete the following steps (as applicable) and
Step E - Communication with Parents/Guardians.
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STEP B1
Other Concussion Signs
Check ( ) visual cues (what you see).
Lying motionless on the playing surface (no loss of consciousness)
Disorientation or confusion, or an inability to respond appropriately to questions
Balance, gait difficulties, motor incoordination, stumbling, slow labored movements
Slow to get up after a direct or indirect hit to the head
Blank or vacant look
Facial injury after head trauma
STEP B2
Other Concussion Symptoms reported (what the student is saying)
Check ( ) what you feel.
Headache
Blurred vision
More emotional
Difficulty concentrating
“Pressure in head”
Sensitivity to light
More irritable
Difficulty remembering
Balance problems
Sensitivity to noise
Sadness
Feeling slowed down
Nausea
Fatigue or low energy
Nervous or anxious
Feeling like “in a fog"
Drowsiness
“Don’t feel right”
Dizziness
IF ANY SIGN(S) OR SYMPTOM(S) WORSEN, CALL 911
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STEP B3
Conduct Quick Memory Function Check
Questions may need to be modified for very young students, the situation/activity/sport and/or students
receiving special education programs and services. Failure to answer any one of these questions
correctly indicates a suspected concussion. Record student responses below.
What room are we in right now? Answer:
What activity/sport/game are we playing now? Answer:
What field are we playing on today? Answer:
Is it before or after lunch? Answer:
What is the name of your teacher/coach? Answer:
What school do you go to? Answer:
STEP C
Where sign(s) observed and/or symptom(s) are reported, and/or if the student fails to answer
any of the Quick Memory Function questions correctly
Actions Required:
a concussion should be suspected;
the student must stop participation immediately and must not be allowed to return to play
that day even if the student states that they are feeling better; and
the student must not:
o leave the premises without parent/guardian (or emergency contact) supervision;
o drive a motor vehicle until cleared to do so by a medical doctor or a
nurse practitioner;
o take medications except for life threatening medical conditions (for example, diabetes, asthma).
Teacher/coach to inform parent/guardian that the student needs urgent Medical Assessment (as soon as
possible that day) by a medical doctor or nurse practitioner. Medical doctors and nurse practitioners are
the only healthcare professionals in Canada with licensed training and expertise to diagnose a
concussion; therefore all students with a suspected concussion should undergo evaluation by one of these
professionals. In rural or northern regions, the Medical Assessment may be completed by a nurse with pre-
arranged access to a medical doctor or nurse practitioner.
Parent/guardian must be provided with a completed copy of this incident report and a copy of the
Medical Assessment Document. Teacher/coach informs principal of incident . 11
STEP D
If there are no signs observed, nor symptoms reported, and the student answers correctly
all questions in the Quick Memory Function Check but a possible concussion event was
recognized by teacher/coach.
Actions Required:
The student must stop participation immediately and must not be allowed to return to
play that day even if the student states that they are feeling better. Principals must be
informed of the incident.
Teacher/coach to inform parent/guardian and principal of the incident and that the student requires
continued monitoring for 24 hours as sign(s) and or symptom(s) can appear hours or days after the
incident:
If any red flags emerge call 911 immediately.
If any other sign(s) and/or symptom(s) emerge, the student needs urgent Medical
Assessment (as soon as possible that day) by a medical doctor or nurse practitioner.
Parent/guardian is to communicate the results of the Medical Assessment to the school
Principal using the Medical Assessment Document.
If after 24hours of monitoring no sign(s)and or symptom(s)have emerged the
parent/guardian is to communicate the results to the school Principal using the Medical
Assessment Form. Student is permitted to resume physical activities. Medical Clearance is
not required.
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STEP E
Communication to Parent/Guardian:
Copy of the Incident Report – Indicate ( ) appropriate results and follow-up requirements.
Your child/ward was checked for a suspected concussion (i.e., Red Flags, Other Signs and Symptoms, Quick
Memory Function) with the following results:
Red Flag(s) sign(s) observed and/or symptom(s) reported and EMS called.
Other concussion sign(s) were observed and/or symptom(s) reported and/or student failed to
correctly answer all the Quick Memory Function questions.
No sign(s) or symptom(s) were reported and student correctly answered all of the
questions in the Quick Memory Function Check but a possible concussion event was
recognized. Continued monitoring is required.
Teacher/Coach/Intramural Supervisor name:
Forms for Parent/Guardian to accompany the Incident Report:
Medical Assessment Document
Parent/Guardian:
Must communicate to principal/designate the results of the Medical Assessment and the results of 24
hour monitoring (using the Medical Assessment Document, and accompanied by a
Doctor’s Note):
Medical Assessment Document
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Documentation of Medical Assessment
Student Name: Date:
The student must be assessed as soon as possible by a medical doctor or nurse practitioner. In Canada, only
medical doctors and nurse practitioners are qualified to provide a concussion diagnosis. In rural or northern
regions, a nurse with pre-arranged access to a medical doctor or nurse practitioner may be used to assess the
suspected concussion. Prior to returning to school, the parent/guardian must inform the school principal of
the results of the medical assessment by completing the following:
RESULTS OF MEDICAL ASSESSMENT
My child/ward has been assessed and a concussion has not been diagnosed and therefore may resume full
participation in learning and physical activity without any restrictions, and
No concussion sign(s) and/symptom(s) observedorreportedafter24hoursmonitoring.
My child/ward has been assessed and a concussion has not been diagnosed but the assessment led to the
following diagnosis and recommendations:
My child/ward has been assessed and a concussion has been diagnosed and therefore must begin
a medically supervised, individualized, and gradual Return to School/Learn (RTS) and Return to
Physical Activity (RTPA) Plan. I will report the findings to the school Principal/designate; and
obtain a copy of the Home Preparation for Return to School/Learn (RTS) and Return to Physical
Activity (RTPA) Plan from the school.
Comments:
Medical Doctor/Nurse Practitioner providing assessment:
Name: Phone Number
Date:
Parent/Guardian Signature: Date: _
* This document should be accompanied by a Doctor’s Note
Staple and file both documents in student OSR. 14
This form is to be provided to all students suspected of having a concussion. The injury may have
occurred during a TCDSB related activity or during a non-related TCDSB activity.
Consult the Sample Tool to identify a Concussion.
CONCUSSION DIAGNOSED:
STEP 1 - Home Preparation for Return to School/Learn (RTS) and Return to Physical Activity (RTPA) Plan
Home Preparation for Return to School/Learn (RTS)
Stages
Home Preparation for Return Physical Activity (RTPA)
Stages
Each stage must last a minimum of 24 hours. Each stage must last a minimum of 24 hours.
RTS–Initial Rest
24 – 48 hours of relative cognitive rest (sample
activities below):
Sample activities permitted if tolerated by student
RTPA –Initial Rest
24 – 48 hours of relative physical rest (sample
activities below):
Sample activities permitted if tolerated by student
Short board/card games
Short phone calls
Photography (with camera)
Crafts
Activities that are not permitted at this stage
TV
Technology use(e.g., computer, laptop, tablet,
iPad)/cell phone (e.g.,texting/games/
photography)
Video games
Reading
Attendance at school or school-type work
Limited movement that does not increase heart
rate or break a sweat
Moving to various locations in the home
Daily hygiene activities
Activities that are not permitted at this stage
Physical exertion (increases breathing and
heart rate and sweating)
Stair climbing other than to move locations
throughout the home
Sports/sporting activity
Student moves to RTS Stage 1 when:
Symptoms start to improve or after resting 2
days maximum (whichever occurs first).
Student moves to RTPA Stage 1 when:
Symptoms start to improve or after resting 2
days maximum (whichever occurs first).
STAGE 1 – HOME PREPARATION TO RETURN TO SCHOOL/LEARN / RETURN TO
PHYSICAL ACTIVITY
RTS – Stage1
Light cognitive (thinking/memory/ knowledge)
activities (as per activities permitted listed below).
Gradually increase cognitive activity up to 30
minutes. Take frequent breaks.
Activities permitted if tolerated by student
Activities from previous stage
Easy reading (e.g., books, magazines, etc…)
Limited TV
Limited cellphone conversations
Drawing/building blocks/puzzles
Some contact with friends
Activities that are not permitted at this stage
Technology use (e.g., computer, laptop, tablet,
iPad)/cell phone (e.g. texting/game/photography)
Attendance at school or school-type work
RTPA – Stage1
Light physical activities (as per activities permitted
listed below) that do not provoke symptoms.
Movements that can be done with little effort (do
not increase breathing and/or heart rate or break a
sweat).
Activities permitted if tolerated by student
Daily household tasks (e.g., bed- making,
dishes, feeding pets, meal preparation)
Slow walking for short time
Activities that are not permitted at this stage
Physical exertion (increases breathing and heart rate
and sweating)
Sports/sporting activity
Stair climbing, other than to move locations
throughout the home
Student moves to RTS Stage 2 when:
Student tolerates 30 minutes of light
cognitive activity (for example a student
should be able to complete 3-4 of the
permitted activities listed above) and has not
exhibited or reported a return of symptoms,
new symptoms, or worsening symptoms.
Student has completed a minimum of 24
hours at RTS – Stage 1.
Student has exhibited or reported a return of
symptoms, or new symptoms and must return
to the previous stage for a minimum of 24
hours.
Student has exhibited or reported a
worsening of symptoms and must return to
medical doctor or nurse practitioner.
Student moves to RTPA Stage 2a when:
Student tolerates light physical activities
(completes both activities above) and has not
exhibited or reported a return of symptoms,
new symptoms, or worsening symptoms.
Student has completed a minimum of 24 hours
at RTPA – Stage 1.
Student has exhibited or reported a return of
symptoms, or new symptoms and must return
to the previous stage for a minimum of 24
hours.
Student has exhibited or reported a
worsening of symptoms and must return to
medical doctor or nurse practitioner.
STAGE 2 – HOME PREPARATION TO RETURN TO SCHOOL/LEARN / RETURN TO
PHYSICAL ACTIVITY
RTS -Stage 2
Gradually add cognitive activity (as per activities
permitted listed below). When light cognitive
activity is tolerated, introduce school work (at
home and facilitated by the school).
Activities permitted if tolerated by student
Activities from previous stage
School-type work in 30-minute increments
Crosswords, word puzzles, Sudoku, word
search
Limited technology use (e.g., computer,
laptop, tablet, iPad)/cell phone (e.g.,
texting/games/photography) starting with
shorter periods and building up as tolerated
Activities that are not permitted at this stage
School attendance
RTPA –Stage 2a
Daily activities that do not provoke
symptoms.
Add additional movements that do not increase
breathing and/or heart rate or break a sweat.
Activities permitted if tolerated by student
Activities from previous stage
Light physical activity (e.g., use of stairs)
10-15 minutes slow walking 1-2x per day
inside and outside (weather permitting)
Activities that are not permitted at this stage
Physical exertion (increases breathing and/or
heart rate and sweating)
Sports
Sporting activities
Student moves to RTS Stage 3a when:
Student tolerates the additional cognitive
activity (for example a student should be
able to complete 3-4 of the activities
permitted) and has not exhibited or
reported a return of symptoms, new
symptoms, or worsening symptoms
Student has completed a minimum of 24
hours at RTS – Stage 2.
Student moves to RTPA Stage 2b when:
Student tolerates daily physical activities
(completes activities permitted listed
above) and has not exhibited or reported a
return of symptoms, new symptoms, or
worsening symptoms.
Student has completed a minimum of 24
hours at RTPA – Stage 2a.
Student has exhibited or reported a return
of symptoms, or new symptoms and must
return to the previous stage for a minimum
of 24 hours.
Student has exhibited or reported a
worsening of symptoms and must
return to medical doctor or nurse
practitioner.
Student has exhibited or reported a return of
symptoms, or new symptoms and must return
to the previous stage for a minimum of 24
hours.
Student has exhibited or reported a
worsening of symptoms and must return to
medical doctor or nurse practitioner.
RTPA- Stage 2b Light aerobic activity
Activities permitted if tolerated by student
20-30 minutes walking/stationary
cycling/recreational (i.e., at a pace that causes
some increase in
breathing/heart rate but not enough to prevent a
student from carrying on a conversation
comfortably)
Activities that are not permitted at this stage
Resistance or weight training
Physical activities with others
Physical activities using equipment
Student moves to RTPA Stage 3 when:
Student tolerates light aerobic activities
(completes activities above) and has not exhibited
or reported a return of symptoms, new symptoms,
or worsening symptoms
Student has completed a minimum of 24 hours at
RTPA – Stage 2b.
END OF STAGE 2:
HOME PREPARATION TO RETURN TO SCHOOL/LEARN / RETURN TO PHYSICAL
ACTIVITY
To be completed and signed by the parent/guardian and handed into the Principal
Responsibilities of Parent/Guardian
When your child has successfully completed Step 1, and Stages 1 and 2 of Home
Preparation for Return to School/Learn (RTS) and Return to Physical Activity (RTPA)
please call or meet to inform the school principal; and hand in this completed and signed
form:
My child has completed Stage 2 RTS (tolerates up to 1 hour of cognitive activity in
two 30 minutes intervals and has not exhibited or reported a return of symptoms,
new symptoms, or worsening symptoms.) and is to begin RTS Stage 3a at school.
My child has completed Stage 2b RTPA (activities are tolerated and has not
exhibited or reported a return of symptoms, new symptoms, or worsening
symptoms.) and is to begin RTPA Stage 3 at school.
Parent/Guardian Signature: Date:
Next Steps:
Meet with the school to review the School Concussion Management Plan for Return to School/Learn
/ Return to Physical Activity
19
STAGE 3 – RETURN TO SCHOOL/LEARN / RETURN TO PHYSICAL ACTIVITY
Return to School/Learn (RTS) Stages Return to Physical Activity (RTPA) Stages
RTS - Stage 3a
Student begins with an initial time at school of 2
hours.
The individual RTS Plan is developed by
Collaborative Team following the student
conference and assessment of the student’s
individual needs determining possible strategies
and/or approaches for student learning (consult
Table 5 in Appendix C-1).
Activities permitted if tolerated by student
Activities from previous stage (consult
Appendix C-1 – Sample Documentation for
Concussion Management – Home Preparation
for RTS and RTPA)
School work for up to 2 hours per day in smaller
chunks (completed at school) working up to a
1/2 day of cognitive activity
Adaptation of learning strategies and/or
approaches
Activities that are not permitted at this stage
Tests/exams
Homework
Music class
Assemblies
Field trips
RTPA –Stage 3
Simple locomotor activities/sport-specific exercise
to add movement.
Activities permitted if tolerated by student
Activities from previous stage (20-30 minutes
walking/stationary
cycling/elliptical/recreational dancing at a
moderate pace)
Simple individual drills (e.g.,
running/throwing drills, skating drills in
hockey, shooting drills in basketball) in
predictable and controlled environments with no
risk of re-injury
Restricted recess activities (e.g., walking)
Activities that are not permitted at this stage
Full participation in physical education or DPA
Participation in intramurals
Full participation in interschool practices
Interschool competitions
Resistance or weight training
Body contact or head impact activities
(e.g., heading a soccer ball)
Jarring motions (e.g., high speed stops, hitting a
baseball with a bat)
School
Student has demonstrated they can tolerate up
to a half day of cognitive activity.
Stage 3a RTS/Stage 3 RTPA plan sent home
School Initial (e.g., collaborative
team lead/designate):
Date:
School
Student has demonstrated they can tolerate
simple individual drills/sport-specific drills
as listed in permitted activities.
Stage 3a RTS/Stage 3 RTPA plan sent home
School Initial (e.g., collaborative
team lead/designate):
Date:
Home
Student has not exhibited or reported a return
of symptoms, new symptoms, or worsening
symptoms.
Student has exhibited or reported a return of
symptoms, or new symptoms, and must return
to the previous stage for a minimum of 24
hours.
Student has exhibited or reported a
worsening of symptoms and must return
to medical doctor or nurse practitioner.
Stage 3a RTS/Stage 3 RTPA plan sent back
Parent/Guardian:
Signature:
Date:
Comments:
Home
Student has not exhibited or reported a return of
symptoms, new symptoms, or worsening
symptoms.
Student has exhibited or reported a return of
symptoms, or new symptoms, and must
return to the previous stage for a minimum
of 24 hours.
Student has exhibited or reported a
worsening of symptoms and must return to
medical doctor or nurse practitioner.
Stage 3a RTS/Stage 3 RTPA plan sent back
Parent/Guardian:
Signature:
Date:
Comments:
RTS - Stage 3b
Student continues attending school half time with
gradual increase in school attendance time,
increased school work and a decrease in the
adaptation of learning strategies and/or
approaches.
Activities permitted if tolerated by student
Activities from previous stage
School work for 4-5 hours per day, in smaller
chunks (e.g., 2-4 days of school/week)
Homework – up to 30 minutes per day
Decrease adaptation of learning strategies
and/or approaches
Classroom testing with accommodations.
Activities that are not permitted at this stage
Standardized tests/exams
School
Student has demonstrated they can tolerate
up to 4-5 hours of the cognitive activities listed
above.
Stage 3b RTS Plan sent home.
School Initial (e.g., collaborative
team
lead/designate):
Date:
Home
Student has not exhibited or reported a return of
symptoms, new symptoms, or worsening
symptoms.
Student has exhibited or reported a return of
symptoms, or new symptoms, and must return
to the previous stage for a minimum of 24
hours.
Student has exhibited or reported a worsening
of symptoms and must return to medical
doctor or nurse practitioner.
Stage 3b RTS plan sent back to school.
Parent/Guardian Signature:
Date:
Comment:
STAGE 4 – RETURN TO SCHOOL/LEARN / RETURN TO PHYSICAL ACTIVITY
Return to School/Learn (RTS) Stages Return to Physical Activity (RTPA) Stages
RTS– Stage 4a
Full day school, minimal adaptation of learning
strategies and/or approaches
Nearly normal workload.
Activities permitted if tolerated by student
Activities from previous stage
Nearly normal cognitive activities
Routine school work as tolerated
Minimal adaptation of learning
strategies and/or approaches
Start to eliminate adaptation of learning
strategies and/or approaches
Increase homework to 60 minutes per day
Limit routine testing to one test per day
with accommodations (e.g., supports -
such as more time)
Activities that are not permitted at this stage
Standardized tests/exams
RTPA –Stage 4
Progressively increase physical activity. Non-
contact training drills to add coordination and
increased thinking.
Activities permitted if tolerated by student
Activities from previous stage
More complex training drills (e.g., passing
drills in soccer and hockey)
Physical activity with no body contact
(e.g., dance, badminton)
Participation in practices for non- contact
interschool sports (no contact)
Progressive resistance training may be started
Recess – physical activity running/games
with no body contact
DPA (elementary)
Activities that are not permitted at this stage
Full participation in physical education
Participation in intramurals
Body contact or head impact activities (e.g.,
heading a soccer ball)
Participation in interschool contact sport practices,
or interschool games/competitions (non-contact and
contact)
School
Student has demonstrated they can tolerate a
full day of school and a nearly normal
workload with minimal adaptation of learning
strategies and/or approaches.
Stage 4a RTS/Stage 4 RTPA sent home
School Initial (e.g., collaborative team
lead/ designate):
Date:
School
Student has completed the activities in
RTPA Stage 4 as applicable.
Stage 4a RTS/ Stage 4 RTPA sent home to parent
Documentation for Medical Clearance sent
home to parent/guardian.
School Initial (e.g., collaborative team lead/
designate):
Date:
Home
Student has not exhibited or reported a return of
symptoms, new symptoms, or worsening
symptoms.
Student has exhibited or reported a return of
symptoms, or new symptoms, and must return
to the previous stage for a minimum of 24
hours.
Student has exhibited or reported a worsening
of symptoms and must return to medical
doctor or nurse practitioner.
C-5 Stage 4a RTS/Stage 4 RTPA sent
back Parent/Guardian:
Signature:
Date:
Comments:
Home
Student has not exhibited or reported a return of
symptoms, new symptoms, or worsening
symptoms.
Student has exhibited or reported a return of
symptoms, or new symptoms, and must return to
the previous stage for a minimum of 24 hours.
Student has exhibited or reported a worsening of
symptoms and must return to medical doctor or
nurse practitioner.
Stage 4a RTS/Stage 4 RTPA sent
back Parent/Guardian:
Signature:
Date:
Comments:
RTS - Stage 4b
At school: full day, without adaptation of learning
strategies and/or approaches
Activities permitted if tolerated by student
Normal cognitive activities
Routine school work
Full curriculum load (attend all classes,
all homework, tests)
Standardized tests/exams
Full extracurricular involvement (non-
sport/non-physical activity - e.g.,
debating club, drama club, chess club)
Before progressing to RTPA Stage 5, the student
must:
have completed RTS Stage 4a and 4b (full day
at school without adaptation
of learning strategies and/or approaches),
have completed RTPA Stage 4 and be symptom-
free, and
obtain a signed Medical Clearance from a
medical doctor or nurse practitioner.
Please Note: Premature return to contact sports (full
practice and game play) may cause a significant
setback in recovery.
School
Student has demonstrated they can tolerate a
full day of school without adaptation of
learning strategies and/or approaches
Stage 4b RTS plan sent home.
School Initial (e.g., collaborative team
lead/ designate):
Date:
Home
Student has not exhibited or reported a return of
symptoms, new symptoms, or worsening
symptoms.
Student has exhibited or reported a return of
symptoms, or new symptoms, and must return
to the previous stage for a minimum of 24
hours.
Student has exhibited or reported a worsening
of symptoms and must return to medical
doctor or nurse practitioner.
Parent/Guardian:
Signature:
Date:
Comments:
End of Stage 4
Documentation for Medical Clearance
This form is to be provided to students who have completed the Return to School/Learn (RTS) Stage 4b
and Return to Physical Activity (RTPA) Stage 4 (consult the School Concussion Management Plan
below). Student must be medically cleared by a medical doctor/nurse practitioner prior to moving on to
full participation in non-contact physical activities and full contact practices (RTPA Stage 5).
Student Name: Date:
I have examined this student and confirm they are medically cleared to participate in the following
activities:
Full participation in Physical Education classes
Full participation in Intramural physical activities (non-contact)
Full participation in non-contact Interschool Sports (practices and competition)
Full-contact training/practice in contact Interschool Sports Other comments:
Medical Doctor/Nurse Practitioner
In rural or northern regions, the Medical Clearance Letter may be completed by a nurse with pre- arranged
access to a medical doctor or nurse practitioner. Forms completed by other licensed healthcare professionals
will not be accepted.
Name:
Signature:
Date:
* This document should be accompanied by a Doctor’s Note 26
End of Stage 4
Documentation for Medical Clearance (page 2)
School Concussion Management Plan Summary
What if symptoms recur? A student who has received Medical Clearance and has a recurrence of
symptoms or new symptoms appear, must immediately remove themselves from play, and inform their
parent/guardian/teacher/coach, and return to medical doctor or nurse practitioner for Medical Clearance
reassessment before returning to physical activity.
School Concussion Management Plan
Return to School/Learn (RTS) Stages Return to Physical Activity (RTPA) Stages
Each stage must last a minimum of 24 hours. Each stage must last a minimum of 24 hours.
RTS - Stage 3a
Student begins with an initial time at
school of 2 hours.
The individual RTS Plan is developed by
Collaborative Team following the student
conference and assessment of the student’s
individual needs determining possible strategies
and/or approaches for student learning.
RTPA –Stage 3
Simple locomotor activities/sport-specific exercise to add
movement.
RTS - Stage 3b
Student continues attending school half time with
gradual increase in school attendance time,
increased school work, and decrease in learning
strategies and/or approaches.
End of Stage 4
Documentation for Medical Clearance (page 3)
School Concussion Management Plan Summary (con’t)
RTS– Stage 4a
Full day school, minimal adaptation of learning
strategies and/or approaches. Nearly normal
workload.
RTPA –Stage 4
Progressively increase physical activity. Non- contact
training drills to add coordination and increased
thinking.
RTS - Stage 4b
At school: full day, without adaptation of learning
strategies and/or approaches.
Before progressing to RTPA Stage 5, the
student must:
have completed RTS Stage 4a and 4b (full day at
school without adaptation of learning strategies and/or
approaches
have completed RTPA Stage 4 and be symptom- free,
and obtain signed Medical Clearance from a medical
doctor or nurse practitioner.
RTPA–Stage 5
Following medical clearance, full participation in all
non-contact physical activities (i.e., non- intentional body
contact) and full contact training/practice in contact
sports.
RTPA - Stage 6
Unrestricted return to contact sports
STAGE 5 – RETURN TO SCHOOL/LEARN / RETURN TO PHYSICAL ACTIVITY
Return to School/Learn (RTS) Stages Return to Physical Activity (RTPA) Stages
RTPA–Stage 5 Following medical clearance, full participation in
all non-contact physical activities (i.e., non-
intentional body contact) and full contact
training/practice in contact sports.
Activities permitted if tolerated by student
Physical Education
Intramural programs
Full contact training/practice in contact
interschool sports
Activities that are not permitted at this stage
Competition (e.g., games, meets, events) that
involves body contact
School
Student has successfully completed the applicable
physical activities in RTPA Stage 5.
Stage 5 PTPA plan sent home
School Initial (e.g., collaborative team lead/designate):
Date:
Home
Student has not exhibited or reported a return of
symptoms or new symptoms.
Student has exhibited or reported a return of
symptoms or new symptoms and must return to
medical doctor or nurse practitioner for Medical
Clearance reassessment.
Stage 5 RTPA plan sent back
Parent/Guardian Signature:
Date:
Comment:
STAGE 6 – RETURN TO SCHOOL/LEARN / RETURN TO PHYSICAL ACTIVITY
Return to School/Learn (RTS) Stages Return to Physical Activity (RTPA) Stages
RTPA - Stage 6
Unrestricted return to contact sports. Full
participation in contact sports
games/competitions
School
Student has successfully completed
full participation in contact sports.
Stage 6 RTPA plan sent home.
School Initial (e.g., collaborative team lead/designate):
Date:
Home
Student has not exhibited or reported a return
of symptoms or new symptoms.
Student has exhibited or reported a return of
symptoms or new symptoms and must return
to medical doctor or nurse practitioner for
Medical Clearance reassessment.
Stage 6 RTPA plan sent back to school for
documentation purposes
Parent/Guardian Signature:
Date:
Comment:
TCDSB Permission Form for Athletic Activities
SCHOOL: _______________________________ Student Name: ___________________________
Teacher in Charge/Coach(es) _______________________________________________________
Principal Signature: _________________________________ Date: _________________________
Dear Parent/Guardian, your child has expressed an interest in trying out for and/or participating in
.
Before participating we require (provided in this package):
a) a signed Permission/Consent Form
b) a signed Acknowledgement of Concussion Education
c) a completed Student Health & Safety Medical Information Form
ACTIVITY INFORMATION
Practice Times & Location
Game/Tournament Date(s), Time(s), and Location(s)
Transportation to/from games/tournaments
ELEMENTS OF RISK
Student Accident Insurance Notice:
The Toronto Catholic District School Board does not provide any accidental death, disability, dismemberment/medical/dental expense insurance for student participation in school sponsored activities (e.g., curricular, intramural and interschool). For insurance coverage of injuries, parents/guardians are encouraged to consider a Student Accident Insurance Plan from an insurance company of their choice.
I acknowledge and have read the Elements of Risk and Student Accident Insurance notice.
Parent/Guardian Signature: Date:
ELEMENTS OF RISK NOTICE
The risk of injury exists in every athletic activity. However, due to the very nature of some activities, the risk of injury may increase. Injuries may range from minor sprains and strains to more serious injuries. These injuries result from the nature of the activity and can occur without fault on either the part of the student, the school board or its employees/agents or the facility where the activity is taking place. The safety and well-being of students is a prime concern and attempts are made to manage, as effectively as possible, the foreseeable risks inherent in physical activity. Please call the school to discuss safety concerns related to any physical activity in which your child/ward is participating.
CONCUSSIONS:
Toronto Catholic District School Board concussion policy and procedures will be followed if a student sustains a hit or blow to the head or body and shows signs and/or symptoms of concussion. Please be advised that your child will be removed from the activity and you will be asked to seek medical attention (i.e. medical doctor or nurse practitioner) for your child/ward if signs and/or symptoms of concussion occur. If Red Flag signs/symptoms are present coach/teacher/convenor/event organizer will call 911. Concussion information for parents/guardians and students is available on the TCDSB website under Health and Physical Education. You are advised, along with your child, to review the Heads Up Concussion Information Sheet (attached) For a diagnosed concussion that occurs as a result of activity outside of the school setting, you must inform the school principal as soon as possible.
You are advised to be aware of: • the dangers of participating with a concussion; • the TCDSB concussion policy; and • the importance of encouraging the ethical values of fair play and respect for opponents.
Athlete: I learned about concussion and talked with my parent or coach about what to do if I have a concussion or other serious brain injury. Athlete Name Printed:
Date: Athlete Signature:
Parent: I have read the Heads Up Concussion Information sheet and/or the TCDSB Concussion Guideline Power Point provided on the TCDSB Board website with my child or teen and talked about what to do if they have a concussion or other serious brain injury. Parent/Guardian Name Printed:
Date: Parent/Guardian Signature:
PERMISSION TO PARTICIPATE:
I give permission for my child/ward to participate in tryouts and training for
If my child should be successful in making the team I give permission for my child to participate in games/tournaments; and travel to/from these games/tournaments as indicated on the activity information section of this form. If an alternate travel, accommodation or activity plan for your child has been made, list details on a separate sheet and sign that your permission is given for these changes.
Parent/Guardian Signature: Date:
EMERGENCY CONTACT INFORMATION (Please Print)
Name Relationship to Child
Cell # Work/Home #
Name Relationship to Child
Cell # Work/Home #
TORONTO CATHOLIC DISTRICT SCHOOL BOARD STUDENT’S HEALTH AND SAFETY INFORMATION FORM
The information on this form is collected under the authority of the Education Act, R.S.O. 1991, Section170(1) and will be used for administration of school excursions and in the event of a medical emergency. If you have any questions regarding the collection or use of this information, please contact the school Principal.
School Name:
Name of Child: _ Date of Birth: Sex: Last Name First Name Y- M- D M or F
Student’s Home Address: Number Street City Postal Code
Student’s Home Phone Number:
Mother’s (Guardian’s) Name: ________________________________________ Cell #: _________________
Mother’s (Guardian’s) Address: ___________________________________________________________ (If different from student’s)
Place of Employment: __________________________________________ Phone #: ________________
Father’s (Guardian’s) Name: ________________________________________ Cell #: __________________
Father’s (Guardian’s) Address: ____________________________________________________________ (If different from student’s)
Place of Employment: ___________________________________________ Phone #: ________________
Family Doctor: Phone #: _
Does your child have a Student Plan of Care for one of the following:
Anaphylaxis Asthma Diabetes Epilepsy and Seizure
Provide details of any special condition(s) your child may have which must or should be taken into consideration in
his/her participation in a full academic and physical program:
Allergy: □insect □plant □food □drug/serum □other allergy or sensitivity: __________________
____________________________________________________________ Does your child carry an Epi Pen or AUVI-Q? Yes No
Asthma:_____________________________________________________________________
Diabetes:____________________________________________________________________ Epilepsy or Seizure:____________________________________________________________ Feet or Legs:_________________________________________________________________
Heart: ______________________________________________________________________ Skin: ______________________________________________________________________
TORONTO CATHOLIC DISTRICT SCHOOL BOARD STUDENT’S HEALTH AND SAFETY INFORMATION FORM
Recent illness or operation:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Other: ______________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Concussion(s) date(s): ________________________ __________________________
Details of Concussion: __________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Blood type (if known):____________________________________________________________________
Date of last Tetanus shot (if known): ________________________________________________________
If there are any other medical details that you feel might be of some assistance to the teacher to ensure the safety of
your child, please contact the teacher at school or use the space below to inform the teacher of these details.
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
______________________________________ __________________________
Signature of Parent or Guardian Date
(or student over the age of 18 years or students 16 or 17 years old who have withdrawn from parental control)
_____________________________________ __________________________
Signature of Teacher-in-charge of Excursion Date
CONCUSSION CODE OF CONDUCT PLEDGE
As a coach/teacher/athletic supervisor I will:
Educate my student athletes about the seriousness of concussions and the signs and symptoms of concussions.
Educate my student athletes about the importance of SPEAKING UP when experiencing any signs or symptoms
of a concussion.
Promise my student athletes I will never ask them to play if they are injured and/or are experiencing signs or
symptoms of concussion.
Encourage my student athletes to inform me if they suspect a team mate to have a concussion.
Teach safe contact skills during practice prior to competition and demonstrate respect for the mutual safety of
fellow athletes.
Be a role model for my student athletes, always demonstrating sportsmanship, fair play and Christian values.
I, the student athlete, will:
Learn the signs and symptoms of concussions.
Speak up if I am experiencing any signs or symptoms of concussions and TELL my Teacher/Coach/Supervisor.
Speak up if my fellow classmate/teammate and/or opponent is experiencing any signs or symptoms of
concussions.
Not play injured or return to play from an injury too soon.
Never pressure a fellow teammate to play injured or to return to play from an injury too soon.
Be a role model who always demonstrates sportsmanship, fair play and Christian values.
I, the student athlete’s parent/guardian, will:
Learn the signs and symptoms of concussions using the TCDSB Concussion Guideline PowerPoint and/or Heads
Up information in the TCDSB Concussion Protocol.
Encourage my child/teen to speak up if he/she is experiencing any signs or symptoms of concussions and to tell
his/her Teacher/Coach/Supervisor.
Encourage my child/teen to speak up if his/her fellow classmate/teammate and/or opponent is experiencing any
signs or symptoms of concussions.
Remove my child/teen from the game/activity if he/she is showing signs or symptoms of concussion.
Be a role model who always demonstrates the importance of sportsmanship, fair play and Christian values.
38
Information Sheet
This sheet has information to help protect your children or teens from concussion or other serious brain injury. Use this information at your children’s or teens’ games and practices to learn how to spot a concussion and what to do if a concussion occurs.
A concussion is a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move quickly back and forth. This fast movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging the brain cells.
Sports are a great way for children and teens to stay healthy and can help them do well in school. To help lower your children’s or teens’ chances of getting a concussion or other serious brain injury, you should:
• Help create a culture of safety for the team.
› Work with their coach to teach ways to lower the chances of getting a concussion.
› Talk with your children or teens about concussion and ask if they have concerns about reporting a concussion. Talk with them about their concerns; emphasize the importance of reporting concussions and taking time to recover from one.
› Ensure that they follow their coach’s rules for safety and the rules of the sport.
› Tell your children or teens that you expect them to practice good sportsmanship at all times.
• When appropriate for the sport or activity, teach your children or teens that they must wear a helmet to lower the chances of the most serious types of brain or head injury. However, there is no “concussion-proof” helmet. So, even with a helmet, it is important for children and teens to avoid hits to the head.
Children and teens who show or report one or more of the signs and symptoms listed below—or simply say they just “don’t feel right” after a bump, blow, or jolt to the head or body—may have a concussion or other serious brain injury.
• Appears dazed or stunned.
• Forgets an instruction, is confused about an assignment or position, or is unsure of the game, score, or opponent.
• Moves clumsily.
• Answers questions slowly.
• Loses consciousness (even briefly).
• Shows mood, behavior, or personality changes.
• Can’t recall events prior to or after a hit or fall.
• Headache or “pressure” in head.
• Nausea or vomiting.
• Balance problems or dizziness, or double or blurry vision.
• Bothered by light or noise.
• Feeling sluggish, hazy, foggy, or groggy.
• Confusion, or concentration or memory problems.
• Just not “feeling right,” or “feeling down.”
it’s better to miss one game than the whole season.
To learn more, go to www.cdc.gov/HEADSUP
In rare cases, a dangerous collection of blood (hematoma) may form on the brain after a bump, blow, or jolt to the head or body and can squeeze the brain against the skull. Call 9-1-1 or take your child or teen to the emergency department right away if, after a bump, blow, or jolt to the head or body, he or she has one or more of these danger signs:
• One pupil larger than the other.
• Drowsiness or inability to wake up.
• A headache that gets worse and does not go away.
• Slurred speech, weakness, numbness, or decreased coordination.
• Repeated vomiting or nausea, convulsions or seizures (shaking or twitching).
• Unusual behavior, increased confusion, restlessness, or agitation.
• Loss of consciousness (passed out/knocked out). Even a brief loss of consciousness should be taken seriously.
As a parent, if you think your child or teen may have a concussion, you should:
1. Remove your child or teen from play.
2. Keep your child or teen out of play the day of the injury. Your child or teen should be seen by a health care provider and only return to play with permission from a health care provider who is experienced in evaluating for concussion.
3. Ask your child’s or teen’s health care provider for written instructions on helping your child or teen Return to School/Learn. You can give the instructions to your child’s or teen’s school nurse and teacher(s) and return-to-play instructions to the coach and/or athletic trainer.
Do not try to judge the severity of the injury yourself. Only a health care provider should assess a child or teen for a possible concussion. Concussion signs and symptoms often show up soon after the injury. But you may not know how serious the concussion is at first, and some symptoms may not show up for hours or days.
The brain needs time to heal after a concussion. A child’s or teen’s Return to School/Learn and sports should be a gradual process that is carefully managed and monitored by a health care provider.
Revised 5/2015
To learn more, go to www.cdc.gov/HEADSUP
You can also download the CDC HEADS UP app to get concussion information at your fingertips. Just scan the QR code pictured at left with your smartphone.
CONCUSSION RECOGNITION TOOL 5 © STEP 3: SYMPTOMS
To help identify concussion in children, adolescents and adults
Supported by
RECOGNISE & REMOVE
Head impacts can be associated with serious and potentially fatal brain injuries. The Concussion Recognition Tool
5 (CRT5) is to be used for the identification of suspected concussion. It is not designed to diagnose concussion.
• Headache
• “Pressure in head”
• Balance problems
• Nausea or
vomiting
• Drowsiness
• Dizziness
• Blurred vision
• Sensitivity to light
• Sensitivity
to noise
• Fatigue or
low energy
• “Don’t feel right”
• More emotional
• More Irritable
• Sadness
• Nervous or
anxious
• Neck Pain
• Difficulty
concentrating
• Difficulty
remembering
• Feeling slowed
down
• Feeling like
“in a fog“
STEP 1: RED FLAGS — CALL AN AMBULANCE
STEP 4: MEMORY ASSESSMENT
(IN ATHLETES OLDER THAN 12 YEARS)
If there is concern after an injury including whether ANY of the following signs are observed or complaints are reported then the player should be safely and immediately removed from play/game/activity. If no licensed healthcare professional is available, call an ambulance for urgent medical assessment:
Failure to answer any of
these questions (modified
appropriately for each
sport) correctly may
• “What venue are
we at today?”
• “Which half is it now?”
• “What team did you play
last week/game?”
• “Did your team win
• Neck pain or tenderness
• Double vision
• Severe or increasing headache
• Deteriorating conscious state
suggest a concussion: • “Who scored last
in this game?”
the last game?”
• Weakness or tingling/ burning in arms or legs
• Seizure or convulsion
• Loss of consciousness
• Vomiting
• Increasingly restless,
Remember: • In all cases, the basic principles
of first aid (danger, response,
airway, breathing, circulation)
should be followed.
• Assessment for a spinal
cord injury is critical.
agitated or combative
• Do not attempt to move the player
(other than required for airway
support) unless trained to so do.
• Do not remove a helmet or
any other equipment unless
trained to do so safely.
Athletes with suspected concussion should:
• Not be left alone initially (at least for the first 1-2 hours).
• Not drink alcohol.
• Not use recreational/ prescription drugs.
• Not be sent home by themselves. They need to be with a responsible adult.
• Not drive a motor vehicle until cleared to do so by a healthcare professional.
If there are no Red Flags, identification of possible concussion should proceed to the following steps:
STEP 2: OBSERVABLE SIGNS
Visual clues that suggest possible concussion include:
The CRT5 may be freely copied in its current form for distribution to individuals, teams, groups
and organisations. Any revision and any reproduction in a digital form requires approval by
the Concussion in Sport Group. It should not be altered in any way, rebranded or sold for
commercial gain.
• Lying motionless on
the playing surface
• Slow to get up after
a direct or indirect
hit to the head
• Disorientation or
confusion, or an inability
to respond appropriately
to questions
• Blank or vacant look
• Balance, gait difficulties,
motor incoordination,
stumbling, slow
laboured movements
• Facial injury after
head trauma
ANY ATHLETE WITH A SUSPECTED CONCUSSION SHOULD BE
IMMEDIATELY REMOVED FROM PRACTICE OR PLAY AND SHOULD
NOT RETURN TO ACTIVITY UNTIL ASSESSED MEDICALLY, EVEN IF
THE SYMPTOMS RESOLVE
© Concussion in Sport Group 2017 © Concussion in Sport Group 2017
© C
oncussio
n in
Sport G
roup 2
017
Echem
end
ia RJ, et a
l. Br J Sp
orts Med
20
17;5
1:8
72. d
oi:1
0.1
136
/bjsp
orts-2
01
7-09
75
08C
RT5
872
What is a concussion? A concussion is a brain injury that cannot be seen on routine X-rays, CT scans, or MRIs. It affects the way an
athlete may think and remember things, and can cause a variety of symptoms.
What are the signs and symptoms of a concussion? An athlete does not need to be knocked out (lose consciousness) to have had a concussion. The athlete
might experience one or more of the following:
Thinking Problems Athlete’s Complaints Other Problems
• Does not know time, date, place, period of game, opposing team, score of game
• General confusion
• Cannot remember things that happened before and after the injury
• Knocked out
• Headache
• Dizziness
• Feeling dazed
• Feeling “dinged” or stunned; “having my bell rung”
• Seeing stars, flashing lights
• Ringing in the ears
• Sleepiness
• Loss of vision
• Seeing double or blurry vision
• Stomachache, stomach pain, nausea
• Poor co-ordination or balance
• Blank stare/glassy-eyed
• Vomiting
• Slurred speech
• Slow to answer questions or follow directions
• Easily distracted
• Poor concentration
• Strange or inappropriate emotions (i.e., laughing, crying, getting mad easily)
• Not playing as well
Get medical help immediately if an athlete has any “red flag” symptoms such as neck pain, repeated
vomiting, growing confusion, seizures, and weakness or tingling in their arms or legs. These may be signs of a
more serious injury.
Parachute Concussion Series
Concussion guide for
COACHES AND TRAINERS
rev. 2018-03-14 parachutecanada.org
For concussion info on the go, download the app
Ed Concussion Parachute is Canada’s
leading national charity
dedicated to injury prevention.
Concussion Ed
Concussion guide for coaches and trainers
What causes a concussion? Any blow to the head, face or neck, or a blow to the
body which causes a sudden jarring of the head
may cause a concussion (e.g., a ball to the head,
being checked into the boards).
What should I do if I think an athlete might have a concussion? In all suspected cases of concussion, the athlete
should stop playing right away. Continuing to play
increases their risk of more severe, longer-lasting
concussion symptoms, as well as increases their
risk of other injury.
The Concussion Recognition Tool 5 (CRT5) can be
used by anyone to help recognize the signs and
symptoms of a possible concussion.
The athlete should not be left alone and should be
seen by a doctor as soon as possible that day. They
should not drive.
If the athlete loses consciousness, call an
ambulance to take them to the hospital right away.
Do not move them or remove any equipment such
as a helmet.
The athlete should not return to play the same day.
How long will it take for the athlete to get better? The signs and symptoms of a concussion usually
last for one to four weeks, but may last longer. In
some cases, it may take many weeks or months to
heal. If the athlete has had a previous concussion,
they may take longer to heal.
If the athlete’s symptoms are persistent (i.e., last
longer than two weeks in adults or longer than four
weeks in youth under 18 years old) they should be
referred to a healthcare professional who is an
expert in the management of concussion.
How is concussion treated? After an initial short period of rest (24 to 48 hours),
light cognitive and physical activity can begin, as
long as these don’t worsen symptoms.
As the athlete is recovering from concussion, they
should not do any activities that may make their
symptoms worse. This might mean limiting activities
such as exercising, driving, and screen time on their
phone or other devices.
Recovering from concussion is a process that takes
patience. Going back to activities before the athlete
is ready is likely to make their symptoms worse, and
their recovery may take longer.
When should the athlete go to the doctor? Anyone with a possible head injury should be seen
by a doctor as soon as possible.
The athlete should go back to the doctor
immediately if, after being told they have a
concussion, they have worsening symptoms, such
as:
• being more confused
• headache that is getting worse
• vomiting more than twice
• not waking up
• having any trouble walking
• having a seizure
• strange behaviour
parachutecanada.org
Concussion guide for coaches and trainers
When can the athlete Return to School? On average, students with concussion miss one to
four days of school. Each concussion is unique, so
the athlete may progress at a different rate than
others.
The Return-to-School Strategy provides information
on the stages of returning to the classroom. Return
to School must come before full return to sport.
When can the athlete return to sport? It is very important that an athlete not go back to
full participation in sport if they have any
concussion signs or symptoms. Return to sport and
physical activity must follow a step-wise approach.
In this approach:
• Each stage is at least 24 hours.
• The athlete moves on to the next stage when they can tolerate activities without new or worsening symptoms.
• If any symptoms worsen, the athlete should stop and go back to the previous stage for at least 24 hours.
Stage 1: After an initial 24 to 48 hours of rest,
light cognitive and physical activity can begin, as
long as these don’t worsen symptoms. The athlete
can start with daily activities such as moving around
the home and simple chores, such as making their
bed.
Stage 2: Light aerobic activity such as walking or
stationary cycling, for 10 to 15 minutes. The athlete
shouldn’t do any resistance training or other heavy
lifting.
Stage 3: Individual sport-specific exercise with
no contact for 20 to 30 minutes (e.g., running,
throwing). The athlete shouldn’t do any resistance
training.
Stage 4: Begin practicing with no contact (no
checking, no heading the ball, etc.). Add in more
challenging drills. Start to add in resistance training.
Stage 5: Participate in practice with contact,
once cleared by a doctor.
Stage 6: Full game play or competition.
The Return-to-Sport Strategy provides more
information on the stages of returning to sport.
An athlete should never return to sport until cleared by a doctor! Returning before full recovery from concussion puts
athletes at higher risk of sustaining another
concussion, with symptoms that may be more
severe and last longer.
parachutecanada.org
Additional Resources Return-to-School Strategy http://horizon.parachutecanada.org/en/article/
parachutes-return-to-learn-protocol
Return-to-Sport Strategy http://horizon.parachutecanada.org/wp-content/
uploads/2017/06/Concussion-ReturnToSport.pdf
Canadian Guideline on Concussion in Sport http://www.parachutecanada.org/guideline
Concussion: Baseline Testing http://www.parachutecanada.org/downloads/
injurytopics/BaselineTesting-FactSheet-
Parachute.pdf
Making Headway eLearning (Coaching Association of Canada) https://coach.ca/making-head-way-concussion-
elearning-series-p153487&language=en
What is a concussion? A concussion is a brain injury that cannot be seen on routine X-rays, CT scans, or MRIs. It affects the way a
student may think and remember things, and can cause a variety of symptoms.
What are the signs and symptoms of a concussion? A student does not need to be knocked out (lose consciousness) to have had a concussion. The
student might experience one or more of the following:
Thinking Problems Student’s Complaints Other Problems
• Does not know time, date, place, details about a recent activity
• General confusion
• Cannot remember things that happened before and after the injury
• Knocked out
• Headache
• Dizziness
• Feels dazed
• Feels “dinged” or stunned; “having my bell rung”
• Sees stars, flashing lights
• Ringing in the ears
• Sleepiness
• Loss of vision
• Sees double or blurry
• Stomachache, stomach pain, nausea
• Poor co-ordination or balance
• Blank stare/glassy-eyed
• Vomiting
• Slurred speech
• Slow to answer questions or follow directions
• Easily distracted
• Poor concentration
• Strange or inappropriate emotions (i.e., laughing, crying, getting mad easily)
• Not participating well
Get medical help immediately if a student has any “red flag” symptoms such as neck pain, repeated
vomiting, growing confusion, seizures, and weakness or tingling in their arms or legs. These may be signs of a
more serious injury.
Parachute Concussion Series
Concussion guide for
TEACHERS
rev. 2018-03-14 parachutecanada.org
For concussion info on the go, download the app
Ed Concussion Parachute is Canada’s
leading national charity
dedicated to injury prevention.
Concussion Ed
Concussion guide for teachers
What causes a concussion? Any blow to the head, face or neck, or a blow to the
body which causes a sudden jarring of the head may
cause a concussion (e.g., a ball to the head,
colliding with another person).
What should I do if I suspect a student has a concussion? In all suspected cases of concussion, the
student should stop the activity right away.
Continuing increases their risk of more severe,
longer-lasting concussion symptoms, as well as
increases their risk of other injury.
The Concussion Recognition Tool 5 (CRT5) can be
used by anyone to help recognize the signs and
symptoms of a possible concussion.
The student should not be left alone and should be
seen by a doctor as soon as possible that day. They
should not drive.
If the student loses consciousness, call an
ambulance to take them to the hospital right away.
Do not move them or remove any equipment such
as a helmet.
The student should not return to play the same day.
How long will it take for the student to get better? The signs and symptoms of a concussion often last
for one to four weeks but may last longer. In some
cases, students may take many weeks or months to
heal. If the student has had a concussion before,
they may take longer to heal.
If the student’s symptoms are persistent (i.e., last
longer than four weeks in youth under 18 years old
or last longer than two weeks in students aged 18
or older), they should be referred to a healthcare
professional who is an expert in the management of
concussion.
How is concussion treated? After an initial short period of rest (24 to 48 hours),
light cognitive and physical activity can begin, as
long as these don’t worsen symptoms.
As the student is recovering from concussion, they
should not do any activities that may make their
symptoms worse. This might mean limiting activities
such as exercising, driving, and screen time on their
phone or other devices. If mental activities (e.g.,
reading, using the computer) worsen the student’s
symptoms, they might have to stay home from
school.
Recovering from concussion is a process that takes
patience. If the student goes back to activities
before they are ready, it is likely to make their
symptoms worse, and their recovery might take
longer.
When should the student go to the doctor? Anyone with a possible head injury should be seen
by a doctor as soon as possible.
The student should go back to the doctor
immediately if, after being told they have a
concussion, they have worsening symptoms, such
as:
• being more confused
• headache that is getting worse
• vomiting more than twice
• not waking up
• having any trouble walking
• having a seizure
• strange behaviour
parachutecanada.org
Concussion guide for teachers
When can the student Return to School? The student may find it hard to concentrate in class,
may get a worse headache, or feel sick to their
stomach. They should stay home from school if
being in class makes their symptoms worse. Once
they feel better, they can try going back to school
part time to start (i.e., for half days) and if they are
OK with that, then they can go back full time.
On average, students with concussion miss one to
four days of school. Each concussion is unique, so
the student may progress at a different rate than
others.
The Return-to-School Strategy provides information
on the stages of returning to the classroom. Return
to School must come before full return to sport.
When can the student return to sport and physical activity? It is very important that the student does not go
back to full participation in sport if they have any
concussion signs or symptoms. Return to sport and
physical activity must follow a step-wise approach.
In this approach:
• Each stage is at least 24 hours.
• The student moves on to the next stage when
they can tolerate activities without new or
worsening symptoms.
• If any of the student’s symptoms worsen, they
should stop and go back to the previous stage
for at least 24 hours.
Stage 1: After an initial 24 to 48 hours of rest,
light cognitive and physical activity can begin, as
long as these don’t worsen symptoms. The student
can start with daily activities like moving around the
home and simple chores, such as making their bed.
Stage 2: Light aerobic activity such as walking or
stationary cycling, for 10 to 15 minutes. The student
shouldn’t do any heavy lifting or resistance training
(e.g., bodyweight exercises, weight training).
Stage 3: Individual physical activity with no risk
of contact for 20 to 30 minutes. The student can
participate in simple, individual activities, such as
going for a walk at recess or shooting a basketball.
The student shouldn’t do any resistance training.
Stage 4: Begin practicing with no contact (no
checking, no heading the ball, etc.). Add in longer
and more challenging physical activity. Start to add
in resistance training (if appropriate for the student).
Get clearance from a doctor before moving on to
Stages 5 and 6.
Stage 5: Participate in practice with contact, if
the student plays a contact sport.
Stage 6: Full game play or competition.
The Return-to-Sport Strategy provides more
information on the stages of returning to sport.
The student should never return to sport until cleared by a doctor! Returning before full recovery from concussion puts
the student at higher risk of sustaining another
concussion, with symptoms that may be more
severe and last longer.
parachutecanada.org
Additional Resources Return-to-School Strategy http://horizon.parachutecanada.org/en/article/
parachutes-return-to-learn-protocol
Return-to-Sport Strategy http://horizon.parachutecanada.org/wp-content/
uploads/2017/06/Concussion-ReturnToSport.pdf
Canadian Guideline on Concussion in Sport http://www.parachutecanada.org/guideline
What is a concussion? A concussion is a brain injury that cannot be seen on routine X-rays, CT scans, or MRIs. It affects the way a
child may think and remember things, and can cause a variety of symptoms.
What are the signs and symptoms of a concussion? Your child does not need to be knocked out (lose consciousness) to have had a concussion. Your child
might experience one or more of the following:
Thinking Problems Child’s Complaints Other Problems
• Does not know time, date, place, details about a recent activity
• General confusion
• Cannot remember things that happened before and after the injury
• Knocked out
• Headache
• Dizziness
• Feels dazed
• Feels “dinged” or stunned; “having my bell rung”
• Sees stars, flashing lights
• Ringing in the ears
• Sleepiness
• Loss of vision
• Sees double or blurry
• Stomachache, stomach pain, nausea
• Poor co-ordination or balance
• Blank stare/glassy-eyed
• Vomiting
• Slurred speech
• Slow to answer questions or follow directions
• Easily distracted
• Poor concentration
• Strange or inappropriate emotions (i.e., laughing, crying, getting mad easily)
• Not participating well
It is harder for infants, toddlers, and preschoolers to communicate how they are feeling. If you have a young
child, you might notice any of the following: crying more than usual; unsteady walking; lack of interest in
favourite toys; changes in nursing, eating or sleeping patterns; or loss of new skills, such as toilet training.
Get medical help immediately if your child has any “red flag” symptoms such as neck pain, repeated
vomiting, growing confusion, seizures, and weakness or tingling in their arms or legs. These may be signs of a
more serious injury.
Parachute Concussion Series
Concussion guide for
PARENTS AND CAREGIVERS
rev. 2018-03-14 parachutecanada.org
For concussion info on the go, download the app
Ed Concussion Parachute is Canada’s
leading national charity
dedicated to injury prevention.
Concussion Ed
Concussion guide for parents and caregivers
What causes a concussion? Any blow to the head, face or neck, or a blow to the
body which causes a sudden jarring of the head may
cause a concussion (e.g., a ball to the head,
colliding with another person).
What should I do if I suspect my child has a concussion? In all suspected cases of concussion, your child
should stop the activity right away. Continuing
increases their risk of more severe, longer-lasting
concussion symptoms, as well as increases their
risk of other injury.
The Concussion Recognition Tool 5 (CRT5) can be
used by anyone to help recognize the signs and
symptoms of a possible concussion.
Your child should not be left alone and should be
seen by a doctor as soon as possible that day.
If your child loses consciousness, call an
ambulance to take them to the hospital right away.
Do not move your child or remove any equipment
such as a helmet.
Your child should not return to play the same day.
How long before my child gets better? The signs and symptoms of a concussion often last
for one to four weeks but may last longer. In some
cases, children may take many weeks or months to
heal. If your child has had a concussion before, they
may take longer to heal.
If your child’s symptoms are persistent (i.e., last
longer than four weeks in youth under 18 years old),
they should be referred to a healthcare professional
who is an expert in the management of concussion.
How is concussion treated? After an initial short period of rest (24 to 48 hours),
light cognitive and physical activity can begin, as
long as these don’t worsen symptoms. A medical
doctor, preferably one with experience managing
concussions, should be consulted before beginning
step-wise Return-to-School and Return-to-Sport
Strategies.
As your child is recovering from concussion, they
should not do any activities that may make their
symptoms worse. This might mean limiting activities
such as riding their bike, play wrestling, reading,
working on the computer or playing video games.
Recovering from concussion is a process that takes
patience. If your child goes back to activities before
they are ready, it is likely to make their symptoms
worse, and their recovery might take longer.
When should my child go to the doctor? Anyone with a possible head injury should be seen
by a doctor as soon as possible. If your child is
diagnosed with a concussion, the doctor should
schedule a follow-up visit within the next one to two
weeks.
Take your child back to the doctor immediately if,
after being told they have a concussion, they have
worsening symptoms, such as:
• being more confused
• headache that is getting worse
• vomiting more than twice
• not waking up
• having any trouble walking
• having a seizure
• strange behaviour
When can my child Return to School? Your child may find it hard to concentrate in class,
may get a worse headache, or feel sick to their
parachutecanada.org
Concussion guide for parents and caregivers
stomach. Your child should stay home from school if
being in class makes their symptoms worse. Once
they feel better, they can try going back to school
part time to start (i.e., for half days) and if they are
OK with that, then they can go back full time.
On average, children with concussion miss one to
four days of school. Each concussion is unique, so
your child may progress at a different rate than
others.
The Return-to-School Strategy provides information
on the stages of returning to the classroom. Return
to School/Learn must come before full return to
sport.
When can my child return to sport and physical activity? It is very important that your child does not go back
to full participation in sport if they have any
concussion signs or symptoms. Return to sport and
physical activity must follow a step-wise approach.
In this approach:
• Each stage is at least 24 hours.
• Your child moves on to the next stage when
they can tolerate activities without new or
worsening symptoms.
• If any of your child’s symptoms worsen, they
should stop and go back to the previous stage
for at least 24 hours.
Stage 1: After an initial 24 to 48 hours of rest,
light cognitive and physical activity can begin, as
long as these don’t worsen symptoms. Your child
can start with daily activities such as moving around
the home and simple chores, such as making their
bed.
Stage 2: Light aerobic activity such as walking or
stationary cycling, for 10 to 15 minutes. Your child
shouldn’t do any heavy lifting or resistance training
(e.g., bodyweight exercises, weight training).
Stage 3: Individual physical activity with no risk
of contact for 20 to 30 minutes. Your child can
participate in simple, individual activities, such as
going for a walk at recess or shooting a basketball.
Your child shouldn’t do any resistance training.
Stage 4: Begin practicing with no contact (no
checking, no heading the ball, etc.). Add in longer
and more challenging physical activity. Start to add
in resistance training (if appropriate for your child).
Get clearance from a doctor before moving on to
Stages 5 and 6.
Stage 5: Participate in full practice with contact,
if your child plays a contact sport.
Stage 6: Full game play or competition.
The Return-to-Sport Strategy provides more
information on the stages of returning to sport.
Your child should not return to sport until cleared by a doctor! Returning too soon before full recovery from
concussion puts your child at higher risk of
sustaining another concussion, with symptoms that
may be more severe and last longer.
parachutecanada.org
Additional Resources Return-to-School Strategy http://horizon.parachutecanada.org/en/article/
parachutes-return-to-learn-protocol
Return-to-Sport Strategy http://horizon.parachutecanada.org/wp-content/
uploads/2017/06/Concussion-ReturnToSport.pdf
Canadian Guideline on Concussion in Sport http://www.parachutecanada.org/guideline
Concussion: Baseline Testing http://www.parachutecanada.org/downloads/
injurytopics/BaselineTesting-FactSheet-
Parachute.pdf
What is a concussion? A concussion is a brain injury that cannot be seen on routine X-rays, CT scans, or MRIs. It affects the way you
may think and remember things, and can cause a variety of symptoms.
What are the signs and symptoms of a concussion? You do not need to be knocked out (lose consciousness) to have had a concussion. You might
experience one or more of the following:
Thinking Problems How You Might Feel Other Problems
• Do not know time, date, place, period of game, opposing team, score of game
• General confusion
• Cannot remember things that happened before and after the injury
• Knocked out
• Headache
• Dizziness
• Feeling dazed
• Feeling “dinged” or stunned; “having my bell rung”
• Seeing stars, flashing lights
• Ringing in the ears
• Sleepiness
• Loss of vision
• Seeing double or blurry vision
• Stomachache, stomach pain, nausea
• Poor co-ordination or balance
• Blank stare/glassy-eyed
• Vomiting
• Slurred speech
• Slow to answer questions or follow directions
• Easily distracted
• Poor concentration
• Strange or inappropriate emotions (i.e., laughing, crying, getting mad easily)
• Not playing as well
Get medical help immediately if you have any “red flag” symptoms such as neck pain, repeated vomiting,
growing confusion, seizures, and weakness or tingling in your arms or legs. These may be signs of a more
serious injury.
Parachute Concussion Series
Concussion guide for
ATHLETES
rev. 2018-03-14 parachutecanada.org
For concussion info on the go, download the app
Ed Concussion Parachute is Canada’s
leading national charity
dedicated to injury prevention.
Concussion Ed
Concussion guide for athletes
What causes a concussion? Any blow to your head, face or neck, or a blow to
your body which causes a sudden jarring of your
head may cause a concussion (e.g., a ball to the
head, being checked into the boards).
What should I do if I think I might have a concussion? You should stop playing right away. Continuing to
play increases your risk of more severe, longer-
lasting concussion symptoms, as well as increases
your risk of other injury.
Tell a coach, parent, official, or other responsible
person that you are concerned you might have a
concussion. You should not be left alone and
should be seen by a doctor as soon as possible
that day. You should not drive.
If you lose consciousness, an ambulance should be
called to take you to a hospital immediately.
Do not return to play the same day.
What should I do if I think my teammate might have a concussion? If another athlete tells you about symptoms or if you
notice signs they might have a concussion, tell a
coach, parent, official or other responsible person.
They should not be left alone and should be seen
by a doctor as soon as possible that day.
If another athlete is knocked out, an ambulance
should be called to take them to a hospital
immediately.
How long will it take to get better? The signs and symptoms of a concussion usually
last for one to four weeks, but may last longer. In
some cases, it may take many weeks or months to
heal. If you have had a previous concussion, you
may take longer to heal.
If your symptoms are persistent (i.e., last longer
than four weeks if you’re under 18 or last longer
than two weeks if you’re 18 or older) you should be
referred to a healthcare professional who is an
expert in the management of concussion.
How is concussion treated? After an initial short period of rest (24 to 48 hours),
light cognitive and physical activity can begin, as
long as these don’t worsen your symptoms.
As you’re recovering from concussion, you should
not do any activities that may make your symptoms
worse. This might mean limiting activities such as
exercising, driving, and screen time on your phone
or other devices. If mental activities (e.g., reading,
using the computer) worsen your symptoms, you
might have to stay home from school or work.
Recovering from concussion is a process that takes
patience. Going back to activities before you are
ready is likely to make your symptoms worse, and
your recovery may take longer.
When should I go to the doctor? Anyone with a possible head injury should be seen
by a doctor as soon as possible. If you are
diagnosed with a concussion, your doctor should
schedule a follow-up visit with you within the next
one to two weeks.
You should go back to the doctor immediately if,
after being told you have a concussion, you have
worsening symptoms, such as:
parachutecanada.org
Concussion guide for athletes
• being more confused
• headache that is getting worse
• vomiting more than twice
• not waking up
• having any trouble walking
• having a seizure
• strange behaviour
When can I Return to School? You may find it hard to concentrate in class, may
get a worse headache, or feel sick to your stomach.
You should stay home from school if being in class
makes your symptoms worse. Once you feel better,
you can try going back to school part-time to start
(i.e., for half days) and if you are OK with that, then
you can go back full time.
On average, students with concussion miss one to
four days of school. Each concussion is unique, so
you may progress at a different rate than other
people you know.
The Return-to-School Strategy provides information
on the stages of returning to the classroom.
Remember, Return to School/Learn must come
before full return to sport.
When can I return to sport? It is very important that you do not go back to full
participation in sport if you have any concussion
signs or symptoms. Return to sport and physical
activity must follow a step-wise approach.
In this approach:
• Each stage is at least 24 hours.
• Move on to the next stage when you can tolerate activities without new or worsening
symptoms.
• If any symptoms worsen, stop and go back to the previous stage for at least 24 hours.
Stage 1: After an initial 24 to 48 hours of rest,
light cognitive and physical activity can begin, as
long as these don’t worsen your symptoms. Start
with daily activities like moving around your home
and simple chores, such as making your bed.
Stage 2: Light aerobic activity such as walking or
stationary cycling, for 10 to 15 minutes. Don’t do
any resistance training or other heavy lifting.
Stage 3: Individual sport-specific exercise with
no contact for 20 to 30 minutes (e.g., running,
throwing). Don’t do any resistance training.
Stage 4: Begin practising with no contact (no
checking, no heading the ball, etc.). Add in more
challenging drills. Start to add in resistance training.
Stage 5: Participate in practice with contact,
once cleared by a doctor.
Stage 6: Full game play or competition.
The Return-to-Sport Strategy provides more
information on the stages of returning to sport.
Never return to sport until cleared by a doctor! Returning to active play before full recovery from
concussion puts you at higher risk of sustaining
another concussion, with symptoms that may be
more severe and last longer.
parachutecanada.org
Additional Resources Return-to-School Strategy http://horizon.parachutecanada.org/en/article/
parachutes-return-to-learn-protocol
Return-to-Sport Strategy http://horizon.parachutecanada.org/wp-content/
uploads/2017/06/Concussion-ReturnToSport.pdf
Canadian Guideline on Concussion in Sport http://www.parachutecanada.org/guideline
Acknowledgements
Contributors to Past Concussion Protocol and Guidelines
Dan Koenig, Superintendent of Curriculum and Accountability, TCDSB
Loretta Notten, Superintendent of Governance and Policy
Nick Biagini, Program Coordinator Health and Physical Education, TCDSB
Ed Cooling, Retired Resource Teacher, Outdoor Education, TCDSB
Robert Kelly, Resource Teacher, Outdoor Education, TCDSB
Nelli Domingues, Resource Teacher for Health and Physical Education, TCDSB
Paul Solarski, Health and Physical Education Department Head, Brebeuf College School, TCDSB
Frank Piddisi, Superintendent of Special Services, (CEC)
Steve Peters, Vice Principal, (St. Margaret)
Patricia Coburn, Principal, (Mary Ward)
Mario Iamundo, Retired Co-ordinator, (CEC)
Enrica Della Mea, Elementary Health and Physical Education Specialist Teacher, (St. Gabriel)
Lynn Newton, Coach, (Msgr Johnson)
David Pagniello, Elementary Health and Physical Education Specialist Teacher, (Holy Child)
Tracy Parish, (St Martin’s/ APPLE Program, Secondary School Principals Association)
Marguerite Thomson, Principal, (Toronto Catholic Elementary Principals Association)
Mario Bernardo, President, Toronto Elementary Catholic Teachers Association
Lina Naccarato, President, CUPE Local 1328
Felix Salazar, President, Toronto Occasional Teachers Association
Teresa Santoro, Vice-Principal, Dante Alighieri Academy
David Szollosy, President, TSU
2018-19 Revisions Completed by:
Megan Ryan Lamothe – Health and Physical Education Resource Teacher
David Pagniello – Outdoor Education Resource Teacher